[Objective] To evaluate the significance of thromboelastography used in anticoagulation during perioperative period of total hip arthroplasty in the elderly. [Methods] A total of 200 patients who were undergoing total hip arthroplasty in Changsha Central Hospital from May 2018 to December 2020 were enrolled into this study. According to random number table method, they were divided into two groups. Of them, 100 patients were routinely given low-molecular-weight heparin calcium at a fixed program 6 hours after surgery (the fixed group), whereas the remaining 100 patients received anticoagulant therapy based on the results of thromboelastography 6 hours after surgery dynamically (the dynamic group) . The occurrence of postoperative thrombosis was observed, and the results of thromboelastography were compared between the two groups. The parameters of thromboelastography were analyzed by ROC to predict the occurrence of thrombo- sis. [Results] There were no significant differences in operative time, incision length, intraoperative blood loss, postoperative drainage vol- ume, incision healing and time of thrombosis between the two groups (P＜0.05) . However, the dynamic group proved significantly superior to the fixed group in terms of total hospital stay and time to return walking postoperatively (P＜0.05) , additionally, the dynamic group had significantly lower incidence of thrombosis than the fixed group (P＜0.05) . At 24 and 48 days postoperatively, the dynamic group had signifi- cantly higher R and K values, whereas significantly lower MA, Angle-α and CI values than the fixed group (P＜0.05) . As results of ROC analysis, the K value had the highest sensitivity (80.0%) and specificity (99.5%) for predicting thrombogenesis, with AUC=0.924. [Conclusion] Thromboelastography do guide postoperative anticoagulation that effectively regulate coagulation factors and platelet function, reduce the incidence of postoperative lower extremity deep vein thrombosis, and improve surgical safety in total hip arthroplasty.